birth

Information, Symptoms, Treatments and Resources

Cesarean Birth

Cesarean delivery, also called c-section, is surgery to deliver a
baby. The baby is taken out through the mother's abdomen. Most cesarean
births result in healthy babies and mothers. But c-section is major
surgery and carries risks. Healing also takes longer than with vaginal birth.

Most healthy pregnant women with no risk factors for problems during
labor or delivery have their babies vaginally. Still, the cesarean
birth rate in the United States has risen greatly in recent decades.
Today, nearly 1 in 3 women have babies by c-section in this country.
The rate was 1 in 5 in 1995.

Public heath experts think that many c-sections are unnecessary. So
it is important for pregnant women to get the facts about c-sections
before they deliver. Women should find out what c-sections are, why
they are performed, and the pros and cons of this surgery.

Reasons for C-sections

Your doctor might recommend a c-section if she thinks it is safer
for you or your baby than vaginal birth. Some c-sections are planned.
But most c-sections are done when unexpected problems happen during
delivery. Even so, there are risks of delivering by c-section. Limited
studies show that the benefits of having a c-section may outweigh the
risks when:

the mother is carrying more than one baby (twins, triplets, etc.)

the mother has health problems including HIV infection, herpes infection, and heart disease

Patient-requested C-section: Can a Woman Choose?

A growing number of women are asking their doctors for c-sections
when there is no medical reason. Some women want a c-section because
they fear the pain of childbirth. Others like the convenience of being
able to decide when and how to deliver their baby. Still others fear
the risks of vaginal delivery including tearing and sexual problems.

But is it safe and ethical for doctors to allow women to choose
c-section? The answer is unclear. Only more research on both types of
deliveries will provide the answer. In the meantime, many obstetricians
feel it is their ethical obligation to talk women out of elective
c-sections. Others believe that women should be able to choose a
c-section if they understand the risks and benefits.

Experts who believe c-sections should only be performed for medical
reasons point to the risks. These include infection, dangerous
bleeding, blood transfusions, and blood clots. Babies born by c-section
have more breathing problems right after birth. Women who have
c-sections stay at the hospital for longer than women who have vaginal
births. Plus, recovery from this surgery takes longer and is often more
painful than that after a vaginal birth. C-sections also increase the
risk of problems in future pregnancies. Women who have had c-sections
have a higher risk of uterine rupture. If the uterus ruptures, the life of the baby and mother is in danger.

Supporters of elective c-sections say that this surgery may protect
a woman's pelvic organs, reduces the risk of bowel and bladder
problems, and is as safe for the baby as vaginal delivery.

The National Institutes of Health (NIH) and American College of
Obstetricians (ACOG) agree that a doctor's decision to perform a
c-section at the request of a patient should be made on a case-by-case
basis and be consistent with ethical principles. ACOG states that "if
the physician believes that (cesarean) delivery promotes the overall
health and welfare of the woman and her fetus more than vaginal birth,
he or she is ethically justified in performing" a c-section. Both
organizations also say that c-section should never be scheduled before
a pregnancy is 39 weeks, or the lungs are mature, unless there is
medical need.

The C-section Experience

Most c-sections are unplanned. So, learning about c-sections is
important for all women who are pregnant. Whether a c-section is
planned or comes up during labor, it can be a positive birth experience
for many women. The overview that follows will help you to know what to
expect during a nonemergency c-section and what questions to ask.

Before surgery

Cesarean delivery takes about 45 to 60 minutes. It takes place in an
operating room. So if you were in a labor and delivery room, you will
be moved to an operating room. Often, the mood of the operating room is
unhurried and relaxed. A doctor will give you medicine through an
epidural or spinal block, which will block the feeling of pain in part
of your body but allow you to stay awake and alert. The spinal block
works right away and completely numbs your body from the chest down.
The epidural takes away pain, but you might be aware of some tugging or
pushing. See Managing Labor Pain for more information. Medicine that makes you fall asleep and lose all
awareness is usually only used in emergency situations. Your abdomen
will be cleaned and prepped. You will have an IV for fluids and
medicines. A nurse will insert a catheter to drain urine from your
bladder. This is to protect the bladder from harm during surgery. Your
heart rate, blood pressure, and breathing also will be monitored.

Questions to ask:

Can I have a support person with me during the operation?

What are my options for blocking pain?

Can I have music played during the surgery?

Will I be able to watch the surgery if I want?

During surgery

The doctor will make 2 incisions. The first is about 6 inches long
and goes through the skin, fat, and muscle. Most incisions are made
side to side and low on the abdomen, called a bikini incision. Next,
the doctor will make an incision to open the uterus. The opening is
made just wide enough for the baby to fit through. One doctor will use
a hand to support the baby while another doctor pushes the uterus to
help push that baby out. Fluid will be suctioned out of your baby's
mouth and nose. The doctor will hold up your baby for you to see. Once
your baby is delivered, the umbilical cord is cut, and the placenta is
removed. Then, the doctor cleans and stitches up the uterus and
abdomen. The repair takes up most of the surgery time. Questions to ask:

Can my partner cut the umbilical cord?

What happens to my baby right after delivery?

Can I hold and touch my baby during the surgery repair?

When is it okay for me to try to breastfeed?

When can my partner take pictures or video?

After surgery

You will be moved to a recovery room and monitored for a few hours.
You might feel shaky, nauseated, and very sleepy. Later, you will be
brought to a hospital room. When you and your baby are ready, you can
hold, snuggle, and nurse your baby. Many people will be excited to see
you. But don't accept too many visitors. Use your time in the hospital,
usually about 4 days, to rest and bond with your baby. C-section is
major surgery, and recovery takes about 6 weeks (not counting the
fatigue of new motherhood). In the weeks ahead, you will need to focus
on healing, getting as much rest as possible, and bonding with your
baby — nothing else. Be careful about taking on too much and accept
help as needed.

Questions to ask:

Can my baby be brought to me in the recovery room?

What are the best positions for me to breastfeed?

Vaginal Birth After C-section (VBAC)?

Some women who have delivered previous babies by c-section would
like to have their next baby vaginally. This is called vaginal delivery
after c-section or VBAC. Women give many reasons for wanting a VBAC.
Some want to avoid the risks and long recovery of surgery. Others want
to experience vaginal delivery. Of women who try VBAC, 60 percent to 80
percent are able to deliver vaginally.

But VBAC isn't the right choice for everyone. Some women have health
or pregnancy complications that make VBAC unsafe. For other women, the
risks of c-section are more acceptable than the risks of VBAC. Still,
others don't live near a hospital where VBAC is possible.

Your doctor can tell you if you are a good candidate for VBAC. VBAC might be an option for you if:

You have no other uterine scars (aside from the prior c-section) or problems.

You have no known problems with your pelvis.

A doctor will be present during all of labor and delivery and can perform an emergency c-section if needed.

A surgical team is immediately available in case an emergency c-section is needed.

Your doctor can explain the risks of both repeat cesarean delivery
and VBAC. With VBAC, the most serious danger is the chance that the
c-section scar on the uterus will open up during labor and delivery.
This is called uterine rupture. While very rare, uterine rupture is
very dangerous for the mother and baby. Less than 1 percent of VBACs
lead to uterine rupture. But doctors cannot predict if uterine rupture
is likely to occur in a woman. This risk, albeit very small, is
unacceptable to some women.

The percent of VBACs is dropping in the United States for many
reasons. Some doctors, hospitals, and patients have concerns about the
safety of VBAC. Some hospitals and doctors are unwilling to do VBACs
because of fear of lawsuits and insurance or staffing expenses. Many
doctors, however, question

if this trend is in the best interest of
women's health.

Choosing to try a VBAC is complex. If you are interested in a VBAC,
talk to your doctor and read up on the subject. Only you and your
doctor can decide what is best for you. VBACs and planned c-sections
both have their benefits and risks. Learn the pros and cons and be
aware of possible problems before you make your choice.

The Content on this Site is presented in a summary fashion, and is intended to be used for educational and entertainment purposes only. It is not intended to be and should not be interpreted as medical advice or a diagnosis of any health or fitness problem, condition or disease; or a recommendation for a specific test, doctor, care provider, procedure, treatment plan, product, or course of action. Med Help International, Inc. is not a medical or healthcare provider and your use of this Site does not create a doctor / patient relationship. We disclaim all responsibility for the professional qualifications and licensing of, and services provided by, any physician or other health providers posting on or otherwise referred to on this Site and/or any Third Party Site. Never disregard the medical advice of your physician or health professional, or delay in seeking such advice, because of something you read on this Site. We offer this Site AS IS and without any warranties. By using this Site you agree to the following Terms and Conditions. If you think you may have a medical emergency, call your physician or 911 immediately.